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Thoughts for the class of 2021

Last week, I saw someone ask a very simple question on Facebook:

“If you could give one piece of advice to those starting undergrad next week, what would it be?”

The comments were interesting. Several people mentioned how grades, while positioned as the be-all and end-all during undergrad, are not a reflection of your worth or ability as a person. The advice that grades are important, so work hard and do your best, but do not let them dictate how you see yourself, is very good and definitely something people need to hear. On the other hand, this is easier said than done, as for that first position out of undergrad, grades are key to getting your application out of the pile (along with relevant experience/networking). Especially in research heavy fields, success begets success, and the better your grades are, the more likely you are to win awards and scholarships, which then gives you a better chance to win subsequent awards and scholarships. But I don’t think that’s the best advice you can get.

Someone else mentioned that you should spend your time networking, and diversify your viewpoints to encompass ideas and values beyond those that you’re familiar with. There’s definite value in this too. For some, going to college or university is the first time they will be exposed to people outside of their community, especially those who are going to pursue education in a new city, state, or country. The opportunity to broaden your horizons and learn from others, as well as respect and appreciate different viewpoints and value structures, is one that will help shape you as a person. Being able to look at issues from different perspectives, and to appreciate the value of these diverse outlooks will help develop your skills and make you a more well-rounded person. But this isn’t the most important advice I’d give someone entering or in undergrad.

Arizona State University//embedr.flickr.com/assets/client-code.js

For me though, the best advice is that there is no fixed path to success. At the start of undergrad, many first years will have a rigid definition of what they want to do upon graduating: gain admission to medical or law school, getting a job with a top company upon graduation, or embark on graduate education in a specific field. However, in being laser-focused on a singular goal, you risk missing out on opportunities that will enrich your experience and provide you with new and valuable experiences. Seeking out additional experiences that come your way that seem interesting and fun at the time, and stepping off the beaten path to engage in those activities, can be valuable and helpful for developing your perspective. Sometimes those experiences with be positive and incredibly fun, and sometimes, those experiences will be the opposite. However, every experience, both positive and negative, is one you can grow from.

If you continue to do that which you enjoy and love and are passionate about, you’ll have the energy and motivation to push through the tough parts. And if you feel a sense of purpose and a belief in what you’re doing, then you’ll be motivated to go the extra mile and make it your own. The Canadian astronaut Chris Hadfield was asked about pursuing a career as an astronaut, and gave the following answer. It’s one that has stuck with me, and provides another perspective on this same issue.

Decide in your heart of hearts what really excites and challenges you, and start moving your life in that direction. Every decision you make, from what you eat to what you do with your time tonight, turns you into who you are tomorrow, and the day after that. Look at who you want to be, and start sculpting yourself into that person. You may not get exactly where you thought you’d be, but you will be doing things that suit you in a profession you believe in. Don’t let life randomly kick you into the adult you don’t want to become. – Chris Hadfield

Enjoy your undergrad. Enjoy every experience that comes your way, and seize every opportunity. But if, on your journey, you end up taking a path you didn’t expect at the start, don’t become disheartened. There are many paths that lead to your destination, and if you are doing that which you’re passionate about and interested in, every destination represents success.

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Five for fighting, three to six for mumps: Controlling disease outbreaks in the NHL (Part 1)


Editorial note: This piece was co-written by Atif Kukaswadia, PhD, and Ary Maharaj, M.Ed. Atif is a writer for the Public Health Perspectives blog on the PLOS network, and Ary is a writer for Silver Seven, an SBNation blog about the Ottawa Senators hockey team. This piece is being cross-published on both platforms. Enjoy!

INTRODUCTION

When we think of places for disease outbreaks, a few examples quickly come to mind: classrooms, college dorms, crowded trains. Another suggestion? The confines of the National Hockey League, where players are surrounded by literal blood, sweat, and tears. When you watch a hockey game, you’ll routinely see players spitting, swapping saliva through the sharing of water bottles, sweating — either through playing the game, using the same towel to dry themselves off, or rubbing their sweaty glove in another player’s face during a scrum. Add to this the intense travel and training schedule, along with the close quarters players are in between games, and this means that, among other things, the NHL is a breeding grounds for illness, even rare ones that do not generally permeate the public sphere.

 

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2017: What can we expect?

Following up from the end of last year, I thought it would be fun to predict what I think the next 12 months will have in store for us. So lets get to it!

1. Repeal of the Affordable Care Act

President Trump has already made it clear that this is one of his first priorities when he assumes office. The groundwork was already laid with the combination of the Senate passing a budget measure that was supported by Congress, and this week Trump issued an executive order to start rolling back the ACA. Now, the ACA is not without fault as we’ve discussed before; premiums have increased for many users, and the lack of true, universal coverage means many who don’t need coverage would rather pay the penalty than enrol. But repealing it without a replacement could be a disaster for many Americans. The Washington Post estimates that the repeal will kill more than 43,000 annually (based on this study in the NEJM). The impacts will be felt beyond the healthcare system though, with evidence from California suggesting that such a move could affect everyone involved with the health industry ranging from hospitals, food, and transportation services that all work together to provide patient care. Estimates from this study suggest up to 209,000 people would lose their jobs, and it would cost California over $20 billion dollars. It remains to be seen what replacement is offered, but the transition between the two is one that needs to navigated delicately.

 

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2016: A Year in Review

Thanks to all our old and new Public Health Perspectives readers for your support over the year. Your tweets, Facebook comments, and feedback are all really appreciated. Lets wrap up the year by reviewing our most popular stories of 2016.

April 2016: Perhaps there is a drug that can prolong your life. It’s called money

What makes New York different to other US cities? | Photo credit Kah-Wai Lin
What makes New York different to other US cities? | Photo credit Kah-Wai Lin

“A wise man once said that “mo’ money, mo’ problems” (Wallace, 1997). However, despite increases in supposed problems, one of the major benefits is increased life expectancy.

New research published in JAMA last week examined how big a difference earning more money makes in life expectancy, as well as how this changes by geographic location across the United States. Researchers collected tax records from 1.4 billion individuals from 1999 to 2014 aged 40 to 76. Of these, around 4 million men died, compared to 2.7 million women (mortality rates of 596.3 and 375.1 per 100 000 respectively). They examined these data to look at what predicted life expectancy at age 40, after adjusting for race and ethnicity.”

 

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The only way to save Obamacare is to expand it

The Affordable Care Act was a landmark piece of legislation for the United States. While most other G-20 countries already have some form of universal healthcare (either through a single payer system, or mandatory insurance coverage), the US was one of the few countries that did not have one. Arguably, however, it didn’t go far enough, and therein lies its biggest problem.

One of the key provisions in Obamacare was that insurers could not deny coverage based on pre-existing conditions. This was a hugely important for those with serious or chronic illnesses, who would normally be denied coverage. For example, diabetes can cost someone approximately $7900 a year in direct medical expenses, which is a hefty sum if you don’t have insurance coverage. Obamacare mandating that these individuals, and others with similar conditions, have to be able to purchase coverage, is an excellent step forward. However, the business of insurance relies on those who enrol but do not require services subsidising those who enrol and do. In terms of healthcare, this would be low risk people paying and not using services, ensuring high-risk individuals are able to access services. As you can imagine, there is very little incentive for low risk individuals to enrol; a phenomena known as “adverse selection.”

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Basic Income: From an idea to reality

Our current way of dealing with poverty is inefficient at best, with mountains of forms, paperwork, weighed down by bureaucracy and procedures. At worst, it’s stigmatising and judgemental, keeping people in poverty rather than giving them opportunities to break free and elevate themselves out of poverty. One possible solution is providing individuals with a Basic Income (click link for my previous post on the subject).

A selling point for Basic Income is that it can save the government money. By streamlining select government services into one agency, it can reduce inefficiency. In fact, this is something that people on both sides of the political spectrum can agree on – both those who want small government and those who want the government to support our most vulnerable citizens. One example is in Ontario, where a recently published report titled “Finding a Better Way: A Basic Income Pilot Project for Ontario” by Hugh Segal reported that a basic income guarantee would replace Ontario Works and the Ontario Disability Support Program, giving everyone an income of $1320 a month, with an extra $500 for those with a disability. This would effectively replace those two programs with one larger, more comprehensive program that doesn’t require the same intensive oversight and monitoring.

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Which diseases do we get to “fight”?

About two weeks ago, the Hospital for Sick Children, also known as SickKids, launched their new ad campaign. For those who aren’t from Canada, SickKids is based in Toronto, Ontario, is the second largest children’s hospital in the world, and does some truly amazing and inspiring work. I highly recommend watching the ad, as the messaging and production quality is absolutely amazing. The imagery and symbolism is strong, and shows these children as fighters who will vanquish their foes. It shares more in common in terms of tone and imagery with NBA and NFL commercials than typical hospital advertisements.

I have mixed feelings on this ad campaign. On the one hand, it is meant to provide a strong, motivational message to children undergoing treatment, and to help raise funds for the SickKids Foundation. In this, it is wildly successful, with an ad that has been viewed almost half a million times (as of this writing), and one that has sparked lots of discussion. However, while the ad is motivational and empowering, it is not without fault.

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How can one person completely change the results of a survey?

In public health, we rely heavily on samples, as measuring everyone you are interested is often impractical. However, this requires a lot of thought and development in order to avoid unintentionally biasing your sample, as was the case for the USC Dornslife/LA Times Daybreak poll.

Last week, a story came out about how one 19-year old black man in Illinois was single-handedly changing the standings of the US Presidential election. This was based on the results from the USC Dornsife/Los Angeles Times Daybreak, a survey of voter attitudes on “a wide range of political, policy, social and cultural issues.” In this survey, Donald Trump has generally held the lead, until last week, when Hillary Clinton came out in front. Interestingly, this is markedly different than most other national polls, that have shown Clinton is generally ahead, or a much closer contest than that poll would have you believe. So what happened?

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Is plain cigarette packaging just smoke and mirrors?

The Marlboro Man is one of the most iconic advertising images from the 20th century. The cowboy, depicted in some rustic setting, was single-handedly responsible for turning Marlboro’s annual sales from $5 billion a year to over $20 billion a year in the two years after the campaign was introduced. Since the success of that campaign, anti-smoking activists have tried several different ways to limit cigarette advertising. The latest salvo comes in the form of last week’s WHO statement on plain packaging, where they recommended plain packing as part of “comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.” Plain packing standardizes how cigarettes are sold, keeping the picture health warnings, but making the brand names, pack size, colour scheme all identical to limit their appeal.

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